Opinions Differ On Circulation Test In Medicare Scam

May 26, 1988|by ANN WLAZELEK, The Morning Call

A circulation test that nearly 1,000 Pennsylvania and New Jersey physicians offered their patients in an alleged Medicare fraud scheme can be a valuable tool or a worthless exercise, depending on whom you talk to.

Federal Justice Department officials who investigated the scheme believe the test was worthless as used by the podiatrists, chiropractors, osteopathic physicians and some allopathic physicians who contracted with Medical Diagnostic Services Inc. between 1982 and 1985.

"We believe it's a worthless test," said James G. Sheehan, the assistant U.S. attorney in Philadelphia handling the case. "We will allege that as performed by these people under these circumstances, it was not useful," he added when questioned further. "Medicare doesn't reimburse for it because the program doesn't think it's an effective test."

But area doctors who continue to refer patients for the test or perform it today, as well as the medical director of the vascular laboratory at the Lehigh Valley Hospital Center, which has the device, maintain the test has limited, but valid uses.

"In a very limited, restricted sense it is quite valuable," said Dr. William Gee, who oversees vascular testing at LVHC as laboratory director. "It is used widely in top quality institutions and among top quality physicians for specific purposes."

The test, a quick and painless procedure that Medical Diagnostic Services staff conducted in these doctors' offices, is called "photo-electric plethysmography."

In the procedure, a light-sensitive probe is held against the skin to measure the pulse rate (more specifically the change in arterial blood flow in the skin).

It is often called digital photo-electric plethysmography because the sensor(s) is usually placed on the fingers or toes.

Physicians and patients prefer the test, when appropriate, to more advanced and risky procedures involving surgery or injectable dyes.

Knowing the blood flow and related healing probability in the toes or foot can save a limb, according to Dr. Edwin Hart, president of the Lehigh Valley Podiatry Society.

Hart, who said he orders the test once or twice a week, cited a recent case in which the test proved there was sufficient circulation in the foot of a 38-year-old diabetic so that onlytoes, not more, had to be removed.

"Years ago the patient would have had a below-the-knee or above-the-knee amputation," he said.

Chiropractors said the circulatory test can detect narrowing or hardening of the arteries, which could require further medical or surgical treatment to prevent a heart attack or stroke.

Gee said digital photo-electric plethysmography's greatest use is to detect diseased veins and faulty valves. It might also be used on newborns to detect pulse, he said.

Gee believes there are many reasons for doing the test and many medical specialists capable of performing it, but cautions, "It should be restricted to people who know what they're doing and who use it appropriately."

Physicians could be misapplying the test or giving inaccurate interpretation s of the results, he said, but that doesn't mean the test itself is invalid.

Out of the 500 vascular tests performed each month in the LVHC lab, Gee said, only about five are digital photo-electric plethysmographies.

"Whether hypothetically the test is appropriate in some hands and under some circumstances, I don't want to address that," Sheehan said.

He did, however, note that a number of laboratories had applauded the U.S. Justice Department's crackdown on Medical Diagnostic Services.

Sheehan said fraud occurred when Medical Diagnostic Services, which operated under four different corporate names and had five offices, including one in Allentown, paid the doctors $50 per patient for their services and billed Medicare for a different, more sophisticated and expensive circulation test that is covered by the federal health plan.

The more sophisticated test is called segmental plethysmography, he said.

Gee noted that segmental refers to the arms and legs, rather than the fingers and toes, and can still involve the use of the photo-electric monitor. During a segmental exam, the blood pressure cuff is placed at various places on the legs or arms, such as the upper thigh, lower calf and ankle, he said.

Of the 987 physicians involved, 382 were sent letters from Sheehan asking them to settle their civil liability by returning three times what they were paid by Medical Diagnostic Services to the federal government. About two dozen Allentown-area doctors, including about five or six podiatrists, received letters, according to Hart and federal investigators.

None of the doctors was named, Sheehan said, and will not be unless prosecuted. As of yesterday, 15 had settled their claims and a lot more had called to say they would pay, he said.

For physicians who fail to make payment or plead their case by Tuesday, the U.S. attorney's office will begin filing complaints after June 6, Sheehan said.